From the Argentine Society of Pediatrics (SAP), they expressed their concern about the increase in the problematic consumption of substances such as alcohol, energy drinks, tobacco and marijuana. In addition, they referred to the excessive use of information and communication technologies, known as ICTs, and that has to do with the use of cell phones, video games and screens in general.
The information was developed in a document called “The Argentine Society of Pediatrics and problematic consumption: a responsibility of all”.
At work, they clarify that, although many of these uses are rooted in our society in all age groups and are part of our daily lives, without any doubt they can negatively affect -occasionally or sustained over time- physical, mental health , interpersonal relationships and / or with the law, especially in children and adolescents, whose organism is in full development.
These four substances mentioned are the ones that adolescents and young people currently consume the most in Argentina, according to the latest Sedronar survey on this subject, but the use of information and communication technologies (ICTs) can be added as problematic consumption and behavioral addictions. and new technologies, which increased during and after the pandemic.
“In this sense, the International Classification of Diseases of the World Health Organization (ICD 11) and the Diagnostic and Statistical Manual of Mental Disorders (DSM 5) frame the problematic use of ICTs as part of behavioral addictions”, said Nora Poggione, a pediatrician specializing in Adolescence and Secretary of the National Committee for Adolescence of the Argentine Society of Pediatrics (SAP). Among the most used ICTs, specialists highlight social networks, email, video games, services offered on cell phones, screens in general and electronic commerce.
According to data from the 2018 World School Health Survey, half of students aged 13-17 drank alcohol in the last 30 days, being higher in the 16-17 group (67.6%) than in the 13-15 age group (47.7%).
Among those who consumed alcohol, 1 in 3 reported having gotten drunk at some time and this indicator was also higher in the 16-17 year-old group (56.0%) than in the 13-15 group (28.5%). Drunkenness, according to said survey, was higher in women than in men in the 13-15 year-old group (30.7% vs 26.1%) and among those who consumed alcohol, 2 out of 3 students began before the age of 14 years.
For Fabio Bastide, The Pro-Secretary of the SAP National Committee for Adolescence, “it is interesting to highlight the way in which the collective consumption of a certain substance or ICT is contextualized, highlighting its apparent positive values, thus it is erroneously stated: “a glass of wine is good for the heart” or “marijuana is natural and is used for medicinal purposes, so it is less harmful than tobacco”. They are all gadgets “with the aim of covering up and forgetting the negative effects”.
“Alcohol is the leading cause of cirrhosis, brain damage, sleep and behavior disorders, injuries on public roads and violence-related; its consumption during pregnancy and lactation can configure one of the leading causes of mental retardation preventable; likewise, cannabis affects cognitive development and behaviors”, completed Silvia Cabrerizo, Secretary of the SAP’s National Working Group on Problematic Consumption.
The SAP document recognizes that alcohol consumption in young people has a bonding nature, it represents a way to spend time with friends and establish social relationships in a group and obtain recognition.
“In order to study this problem in an integral way, it is necessary to refer to the interaction of variables of an individual order (biological, physiological and psychological), family (parental consumption, availability of drinks, diffuse rules and violence), social (forms of coexistence associated with consumption, pressure from the belonging group, availability of substances, deficient legislation to regulate the sale and of alcoholic beverages) and cultural (symbolisms, beliefs, representations, rituals, customs or traditions that legitimize consumption)”, refers to the work of the SAP.
But the problem is far from being exclusive to alcohol and ICTs: there is also an increase in the use of marijuana and energy drinks and smoking in young people. According to the same EMSE study, an average of 1 out of 10 students used marijuana at some time in their lives and almost 4 out of 10 adolescents between the ages of 13 and 17 tried some illegal drug before the age of 14. 1 in 5 (20.4%) students between the ages of 13 and 17 used some tobacco product during the last 30 days, being more frequent in women than in men. This consumption is double among students from 16 to 17 years old compared to those from 13 to 15 (28.3% vs. 14.6%).
In Argentina, Sedronar resolved to include drinks and drugs advertised as stimulants in the National Plan to Fight Drugs, in the Prevention Chapter.
Although more up-to-date statistics are not available, SAP specialists acknowledge that problematic levels of consumption have now increased after the pandemic, and it is something that is seen every day in pediatric offices.
For this reason, the emphatic recommendation regarding all these types of problematic consumption is to start with prevention earlier, from childhood, including parents’ reflection on family consumption models and involving different actors, fundamentally the school, but also clubs, community centers and NGOs, among others.
“Another of the problematic uses is marijuana, which is one of the most widely consumed drugs worldwide. Its increase is related to the legislation that authorizes cannabis for both medicinal and industrial use and to the misinformation regarding the effects that it can produce in the short and long term.In children and adolescents, psychotic symptoms, cardiovascular alterations and neurodevelopmental alterations, memory alterations, concentration disorders and even, when used chronically, can produce “anhedonia” , which is the inability to enjoy activities or situations that were pleasurable in the past,” described María Eugenia Braschi, a member of the National Working Group on Problematic Consumption of the Argentine Society of Pediatrics.
“Adult consumption of marijuana is not the same as its medicinal use, certain cannabinoids are indicated as a medicine at a certain dose for a certain disease, with a pharmaceutical quality product and with medical monitoring and control,” he completed.
Regarding tobacco, Poggione stated that “currently, one of the ways of incorporating nicotine and tobacco derivatives occurs through the use of vaporization devices called electronic cigarettes and “vapers”.
This adds to the toxic effects of tobacco that of the other components of oils, flavorings and other substances that vaporize. The tobacco industry directs its advertisements to the adolescent public through networks through which they circulate and promote these products as a possible ‘treatment’ for smoking cessation. As a consequence, adolescents start using nicotine.”
The work of the SAP recalls that ‘The World Health Organization (WHO) since 2014 affirms that the vapor released by these devices is not innocuous because it contains nicotine and other toxic and carcinogenic chemicals. In December 2016, through a Sanitary Technology Assessment, ANMAT decided to reiterate the ban on importing, distributing and marketing electronic cigarettes and their accessories -which includes their , promotion and sponsorship.
“Energy drinks, the consumption of which is increased by copious in the different media, contain a high amount of sugar and caffeine -among other substances- and offer no health benefit for adolescents. Its multiple components can facilitate the appearance of adverse and toxic effects if they are combined with commonly used medications and other substances.In turn, its concomitant use with alcohol can mask its depressant effects and facilitate the appearance of cardiac complications.In our country, it is prohibited its sale to those under 18 years of age, but this is not fulfilled in practice. And it is frequently used in early adolescence as an ‘initiation ritual’ of that stage of life,” Bastide said.
“As a health team we must work on prevention and accompaniment through harm reduction policies, as well as in the treatment and rehabilitation processes. This is an increasingly difficult task taking into account the amount of that exists around a legal drug such as alcohol, laws that are not complied with such as the prohibition on the sale of alcohol to minors or the naturalization of its consumption in the previous ones so that there is a “careful consumption”; without forgetting that we live in a consumer society where consuming is well seen”, concludes the SAP document.
recommendations
· Use all the tools at our disposal to mitigate the damage that consumption is causing to our adolescents and young people.
· Focus attention on trying to stop the naturalization that consumption by young people has in society and, above all, on adult leaders who do not see it badly or who endorse “careful consumption” in their homes.
· Reinforce and highlight the damage that these consumptions cause in organisms in formation (liver, heart, brain, etc.), collateral damage (accidents, sexually transmitted diseases and violence, among others) and not stop talking about truncated futures.
The interview in the medical consultation with adolescents and their environment represents an unmissable opportunity to carry out preventive actions on problematic consumption. For this reason, the SAP report provides a series of recommendations to make it successful:
· The medical interview must be carried out in a private environment, in a colloquial language with directed questions, without value judgments and ensuring the consultant’s confidentiality.
· Use exits, the peer group, news, series as gateways on the subject so that the patient can give his or her gaze without feeling judged.
· In the set of data recorded in the patient’s clinical history (anamnesis) always include the consumption of substances (alcohol, tobacco, energy drinks, marijuana, paco, electronic cigarettes, glue, synthetics and others) and use of networks and online games.
· Introduce the concept of leisure and evaluate the management of free time, both in the patient and in his family and peer group.
· Request regular control studies and make an appointment with the patient shortly to resume the conversation and open any issues that have remained pending.
· Conduct interviews before and after graduate trips, UPD (last first day of classes) or graduate parties to assess expectations about these events and provide risk and damage reduction guidelines and to assess how their experience was.